Peroneal Tendon Injury Specialists Aiea HI

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Treating Peroneal Tendon Injuries in Athletes

This article is the first part of a series on disorders of the foot and ankle. Surgeons from the University of North Carolina Department of Orthopedic Surgery provide an update in this sports medicine topic. The specific focus is on peroneal tendon problems causing ankle pain and dysfunction.

The peroneal tendon is divided into two parts: the peroneus longus and the peroneus brevis. It is located on the lateral (outside) of the lower leg and ankle. The two sections start together at the upper portion of the lower leg and travel down the length of the lower leg. Both parts of the tendon wrap around under the ankle bone and then separate again and attache to two separate places on the foot.

Peroneal tendon injuries can occur as a result of misalignment of the ankle, frequent (repeated) ankle sprains, or overuse in athletic activities. It's not a common problem. So, treatment isn't based on evidence from large scientific studies. Instead, surgeons rely on what's referred to as a consensus approach. This means they listen to what the experts have to say and see how others treat it as reported in published case studies.

Several specific conditions affecting the peroneal tendon are presented. The authors describe and discuss peroneal tendinopathy, os peroneum syndrome, peroneal tendon dislocation, and peroneal tendon tears. A special section is included for each one called the Author's Preferred Treatment to help guide other surgeons treating any of these problems.

Tendinopathy refers to any inflammation of the tendon or the sheath (the covering) around the tendon. Dancers, runners, and athletes with chronic ankle instability from repeated ankle sprains are the people most likely to develop this problem. Os peroneum syndrome is a very painful condition caused by fracture of the os peroneum, ruptured tendons around the os peroneum, or entrapment of the os peroneum or peroneus tendon. The os peroneum is an extra little piece of cartilage or bone that is located within the peroneus longus tendon.

Treatment for both peroneal tendinopathies and painful os peroneum syndrome (POPS) begins with conservative (nonoperative) care. Antiinflammatories, shoe (heel) wedges, and physical therapy are the first approaches in care. In some cases of severe pain associated with acute injury, the patient may be put in a short-leg cast (below the knee, including the foot and ankle) or controlled ankle motion (CAM) boot.

Surgery is an alternate treatment option but only after the patient has tried three to six months of conservative care. For patients with tendinopathy, the surgeon uses an open incision to inspect the tendon and tendon sheath. The sheath is cut open and the tendon repaired. The surgeon leaves the tendon sheath unrepaired to prevent further pressure on the tendon.

In the case of a painful os peroneum syndrome, the bone or cartilage fragment is surgically removed. The surgeon must be careful to remove the os pero...

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